Minimizing perinatal neurologic injury at term: is cesarean section the answer?
Despite advances in obstetric and neonatal care, the last several decades have not witnessed an improvement in the prediction or prevention of term cerebral palsy. Obstetric interventions such as electronic fetal heart rate monitoring and cesarean delivery, although biologically plausible as intervention strategies, do not improve perinatal outcomes in clinical practice. In reaction to mounting medicolegal pressure, obstetricians continue to increase the number of cesarean deliveries they perform as a form of defensive medicine, despite evidence that this practice is not associated with improved perinatal outcomes. The current standard for expeditious delivery in a case of potential fetal compromise is described by the "30-minute rule." However, obstetricians' determinations of the need for expedited delivery may be a preferable guide for appropriate delivery timing.
Miller
Russell
R
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH 16-66, New York, NY 10032, USA. rsm20@columbia.edu
Depp
Richard
R
D001720:Birth Injuries / Q000517:prevention & control*; D001930:Brain Injuries / Q000517:prevention & control*; D002547:Cerebral Palsy / Q000517:prevention & control*; D002585:Cesarean Section; D005260:Female; D005316:Fetal Distress / Q000175:diagnosis; D005311:Fetal Hypoxia / Q000175:diagnosis; D005323:Fetal Monitoring / Q000379:methods; D006340:Heart Rate, Fetal / Q000502:physiology; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome